A Case of Euglycemic Diabetic Ketoacidosis Following Long-term Empagliflozin Therapy

Farjo, Peter; Kidd, Kacie M.; Reece, Josephine

doi:10.2337/dc16-0728

Cited by 18 publications

(14 citation statements)

References 4 publications

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“…Several case reports in the endocrinology literature have also emerged since 2013 describing this phenomenon (15)(16)(17)(18)(19)(20). In a majority of these cases, the diagnosis 110 F. Brown and T. McColl of DKA was initially missed because patients were relatively euglycemic on presentation (BG < 20 mmol/ L or < 360 mg/dL).…”

Section: Discussionmentioning

confidence: 99%

Euglycemic Diabetic Ketoacidosis Secondary to Dapagliflozin Use: A Case Report

Brown

McColl

2018

The Journal of Emergency Medicine

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A 53-year-old man with type 2 diabetes mellitus and a recent Roux-en-Y gastric bypass surgery presented to the ED with nausea, vomiting, and generalized abdominal pain. His medications included dapagliflozin. Work-up revealed anion-gap acidosis, which prompted us to send serum ketone levels despite a blood glucose level of 9.8 mmol/L (162 mg/dL). The patient was ultimately diagnosed with euglycemic DKA. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patients on SGLT2 inhibitors may present in DKA despite having normal blood glucose levels. It is important for emergency physicians to be aware of this phenomenon in all SGLT2-inhibitor users, as a delay in the diagnosis of DKA can be life threatening.

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Section: Discussionmentioning

confidence: 99%

Euglycemic Diabetic Ketoacidosis Secondary to Dapagliflozin Use: A Case Report

Brown

McColl

2018

The Journal of Emergency Medicine

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“…We retrieved a total of 105 episodes of DKA in patients receiving SGLT2i from May 2014 to April 2017 . Demographic characteristics, type of diabetes and type of SGLT2i are reported in Table .…”

Section: Review Of the Literaturementioning

confidence: 99%

Sodium‐glucose co‐transporter‐2 inhibitors and diabetic ketoacidosis: An updated review of the literature

Bonora

Avogaro

Fadini

2017

Diabetes Obesity Metabolism

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Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are increasingly used for the treatment of type 2 diabetes (T2D) and can improve glucose control also in type 1 diabetes (T1D). In May 2015, regulatory agencies issued a warning that SGLT2is may cause diabetic ketoacidosis (DKA). We report details on 2 new cases of SGLT2i-associated DKA and review the literature for similar cases within randomized controlled trials (RCTs), cohort studies and single reports. We searched the medical literature for reports of SGLT2i-associated DKA cases. A quantitative analysis of frequency and clinical characteristics is reported. The 2 narrative cases illustrate that SGLT2i-associated DKA can occur in patients with T1D incorrectly diagnosed as T2D, perhaps without the presence of obvious DKA precipitating factors. The incidence of SGLT2i-associated DKA was less than 1/1000 in randomized controlled trials and 1.6/1000 person-years in cohort studies. We retrieved detailed data on 105 SGLT2i-associated DKA case reports, wherein 35% showed glucose levels of less than 200 mg/dL and 22% were not associated with typical triggers. In case reports and in pharmacovigilance databases, duration of SGLT2i treatment before DKA onset was extremely variable. Fatal SGLT2i-associated DKA episodes were found only in pharmacovigilance databases and represented 1.6% of all reported cases. DKA is a rare adverse event during SGLT2i therapy. Predisposing and precipitating factors are still incompletely understood, although a minority of cases lacked typical DKA triggers. More narrative case series and cohort studies are needed to better understand the true risk and the spectrum of this adverse event.

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“…Es obligatorio buscar las causas que pueden predisponer la presencia de cuerpos cetónicos, tales como la deshidratación, restricción de ingesta calórica, reducción de peso, infecciones, cirugía, vómitos, reducción de la dosis de insulina, mal control de la diabetes o ingesta de alcohol (9,10) . Todo esto fue descartado en nuestra paciente, quedando la duda sobre si los bajos niveles de insulina y péptido C fueron ocasionados por un tipo de insulitis por empaglifozina, o si estos niveles ya venían descendiendo antes del cuadro.…”

Section: Discussionunclassified

Cetoacidosis por empagliflozina post histerectomía

León

Ubierna

Zerón

2020

Rev peru ginecol obstet.

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Paciente de sexo femenino de 42 años, con diagnóstico de diabetes mellitus tipo 2, de 3 años de evolución, era tratada con empagliflozina/metformina. Intervenida quirúrgicamente por miomatosis uterina, presentó en el postoperatorio inmediato deterioro neurológico y acidosis metabólica, sin hiperglicemia, pero con desequilibrio hidroelectrolítico. Fue ingresada a terapia intensiva, requiriendo manejo invasivo con hemodiálisis y diálisis peritoneal por acidosis refractaria. Egresó luego de 17 días de estancia intrahospitalaria, en buenas condiciones generales.

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A Case of Euglycemic Diabetic Ketoacidosis Following Long-term Empagliflozin Therapy

Cited by 18 publications

References 4 publications

Euglycemic Diabetic Ketoacidosis Secondary to Dapagliflozin Use: A Case Report

Euglycemic Diabetic Ketoacidosis Secondary to Dapagliflozin Use: A Case Report

Sodium‐glucose co‐transporter‐2 inhibitors and diabetic ketoacidosis: An updated review of the literature

Cetoacidosis por empagliflozina post histerectomía

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